Healthcare Provider Details

I. General information

NPI: 1609798958
Provider Name (Legal Business Name): WILD MARE BIRTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 DERBY CT
FAIRFIELD CA
94533-1304
US

IV. Provider business mailing address

521 DERBY CT
FAIRFIELD CA
94533-1304
US

V. Phone/Fax

Practice location:
  • Phone: 415-466-5744
  • Fax:
Mailing address:
  • Phone: 415-466-5744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name: MARGAUX MARROCCO
Title or Position: OWNER/MANAGER
Credential:
Phone: 415-466-5744